The majority of current efforts to build accountable care organizations are being initiated by hospitals. Sidney S. Welch, JD, attorney at Arnall Golden Gregory and chair of the American Bar Association's Physician Issues Interest Group, says that although hospitals are better positioned to develop ACOs because of their resources, hospital-driven ACOs may not be consistent with the goals of ACOs. Instead, she suggests, physicians, as the hands-on decision-makers regarding patient care, are best positioned to bring accountability to the table. She notes that in a truly successful ACO, patient hospitalizations should decrease significantly.
Hospital-driven ACOs
Many ACO developments have started, whether deliberately or not, with the acquisition of specialty care physicians by hospitals. Ms. Welch says hospitals are now beginning to realize that they also need to build their primary care physician base. She says integration efforts that do not give physicians an active role will have difficulty creating a successful ACO. "There has to be equal hospital and physician governance, voice and participation," she says. Physicians should have an equal number of board seats as hospital leaders, she suggests.
"One of the goals of ACOs," Ms. Welch says, "really is to provide coordinated (and accountable) patient care and management that then allow a number of the other services a patient would need — nursing care, hospice care, etc. — to be at the periphery." By this logic, she argues, physicians should drive the development of ACOs. She suggests that if this trend of hospitals leading ACOs continues, the end result could look quite different from what was intended. "The hospital-based model doesn't get the ACO where it needs to go theoretically," she says.
Physician-driven ACOs
Physicians are limited in their ability to begin ACOs on their own, however, because they lack access to sufficient capital. Ms. Welch says physicians and other stakeholders need to "get creative" to find ways to fund physician-driven ACOs or similar efforts. She says one way for physicians to drive ACO development is for large group practices or multispecialty groups to partner and form a corporate entity that would be the physician "hub" of the organization.
An additional challenge to physician-led ACOs is that many physicians are wary of investing in ACOs, says Ms. Welch. Organizations such as the American Medical Association and state medical societies have begun educating physicians on the different ACO models, which may help physicians understand their role in the new healthcare delivery model.
For physicians considering leadership roles, they may struggle with finding a balance between clinical and managerial work. "There is both a necessity and a tendency on the physicians' part to be immersed in their daily practice so that they don't have time to take a leadership role," Ms. Welch says. She suggests hospitals encourage, seek out and support physician leadership.
Despite hospitals' greater access to resources, including capital, physicians and physician groups may have an opportunity to be more proactive in forming ACOs, thus shaping the future of healthcare.
Learn more about the American Bar Association.
Hospital-driven ACOs
Many ACO developments have started, whether deliberately or not, with the acquisition of specialty care physicians by hospitals. Ms. Welch says hospitals are now beginning to realize that they also need to build their primary care physician base. She says integration efforts that do not give physicians an active role will have difficulty creating a successful ACO. "There has to be equal hospital and physician governance, voice and participation," she says. Physicians should have an equal number of board seats as hospital leaders, she suggests.
"One of the goals of ACOs," Ms. Welch says, "really is to provide coordinated (and accountable) patient care and management that then allow a number of the other services a patient would need — nursing care, hospice care, etc. — to be at the periphery." By this logic, she argues, physicians should drive the development of ACOs. She suggests that if this trend of hospitals leading ACOs continues, the end result could look quite different from what was intended. "The hospital-based model doesn't get the ACO where it needs to go theoretically," she says.
Physician-driven ACOs
Physicians are limited in their ability to begin ACOs on their own, however, because they lack access to sufficient capital. Ms. Welch says physicians and other stakeholders need to "get creative" to find ways to fund physician-driven ACOs or similar efforts. She says one way for physicians to drive ACO development is for large group practices or multispecialty groups to partner and form a corporate entity that would be the physician "hub" of the organization.
An additional challenge to physician-led ACOs is that many physicians are wary of investing in ACOs, says Ms. Welch. Organizations such as the American Medical Association and state medical societies have begun educating physicians on the different ACO models, which may help physicians understand their role in the new healthcare delivery model.
For physicians considering leadership roles, they may struggle with finding a balance between clinical and managerial work. "There is both a necessity and a tendency on the physicians' part to be immersed in their daily practice so that they don't have time to take a leadership role," Ms. Welch says. She suggests hospitals encourage, seek out and support physician leadership.
Despite hospitals' greater access to resources, including capital, physicians and physician groups may have an opportunity to be more proactive in forming ACOs, thus shaping the future of healthcare.
Learn more about the American Bar Association.